Myasthenia Gravis Exacerbation Following Second Dose of mRNA-1273 Vaccine

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Impact of Medicare Part D coverage gap on beneficiaries\u27 adherence to prescription medications

INTRODUCTION: Medicare Part D provides prescription drug coverage to seniors through a benefit plan with a major deductible inserted in the middle. It is important to study the extent to which this structure affects seniors’ adherence to prescription medications. Therefore, this study had the following objectives: (1) To identify characteristics of beneficiaries reaching and not reaching the coverage gap, (2) To study the entry and exit times from the coverage gap, (3) To study the impact of a complete gap in coverage on beneficiaries’ adherence to prescription medications, (4) To study the impact of a partial gap in coverage on beneficiaries’ adherence to prescription medications METHODS: This was a retrospective quasi-experimental analysis with matched control groups using a nationally representative sample of Part D enrollees from 2008 Centers for Medicare and Medicaid (CMS) datasets. Adherence to each oral medication taken for one or more of the seven pre-defined therapeutic classes before and after reaching the coverage gap was measured using the Medication Possession Ratio (MPR). Appropriate statistical tests for significance were performed for each analysis RESULTS: A quarter of our sample (24.42%) reached the coverage gap in 2008. Most of the beneficiaries reaching the coverage gap did so by end of September. Those reaching the coverage gap and losing all coverage experienced significantly greater reductions in adherence (3% more for beta-blockers to 9% more for oral anti-diabetic agents), compared to those not reaching the coverage gap. A considerable proportion of beneficiaries stopped taking medications in both the groups and the proportion of beneficiaries considered adherent also dropped in both the groups during the coverage gap period. CONCLUSIONS: Medicare Part D beneficiaries face significant barriers to adherence and this is especially highlighted among those reaching the coverage gap. Interventions to improve adherence in this group should target all beneficiaries, especially those with several chronic conditions

Evaluation of efficacy of priming dose of propofol in reducing induction dose requirements in patients undergoing elective surgeries under general anaesthesia

Background: Priming principle refers to administration of a subanaestheic dose of an agent prior to its actual anaesthetic dose. Propofol is an effective substitute to thiopentone for intravenous induction. The objectives of the study were to evaluate whether priming with propofol would reduce induction of dose, reduce the peri-intubation haemodynamic changes, influence the severity of side effects and influence recall phenomenon.Methods: Sixty patients of ASA Grade 1 and 2, between 18-55 years of age group, of both sexes, were selected on the basis of eligibility criteria and scheduled for elective surgery under general anaesthesia were divided into study and control groups of 30 patients each. The total dose of propofol including the priming (25% of total) dose of propofol, heart rate and blood pressure, baseline (before induction), immediately after intubation, 1 min, 3 min, 5 min after induction, SPO2 (% of oxygen saturation), recall phenomenon and other side effects post operatively were studied.Results: The demographic data were comparable for age, weight and sex in both the groups. Total patients were divided into two groups with 30 patients each. It was observed that total induction dose of propofol was significantly decreased in the study group 72.33±9.53mg compared to control group 115.83±9.00mg. Heart rate was better maintained in study group with minimal post-intubation response. The values of systolic, diastolic and mean blood pressure observed at 1 min after induction also showed significant decrease in control group compared to study group.Conclusions: Propofol produces smooth, rapid, pleasant and safe induction. Priming with propofol can be practiced due to its cost effectiveness and better haemodynamic profile and safety

Excess Costs Associated with Possible Misdiagnosis of Alzheimer's Disease Among Patients with Vascular Dementia in a UK CPRD Population

The authors would like to acknowledge Julie von Ziegenweidt and Annie Burden (Research in Real Life, UK) for assistance with processing and interpretation of CPRD data, and Gillian Gummer and Caroline Spencer (Rx Communications, Mold, UK) for medical writing assistance with the preparation of this article, funded by Eli Lilly and Company. Authors’ disclosures available online (http://j-alz. com/manuscript-disclosures/15-0685r2).Peer reviewedPublisher PD

p.Val142lle/p.Val122lle (C.424G>A) Transthyretin Mutation Presenting Exclusively As Small Fiber Neuropathy

Familial amyloid polyneuropathy is a rare autosomal dominant disorder caused by mutations in the transthyretin gene, TTR. More than 100 mutations in the TTR gene are known. p.Val30Met was identified first as a cause of FAP and is the most common mutation worldwide. p.Val30Met is associated with peripheral neuropathy while p.Val142lle (C.424G>A) (also known as p.Val122lle)  is associated with cardiac amyloidosis [1, 2, 3] . In this context, we report a patient harboring p.Val142lle mutation with exclusive small fiber neuropathy and absence of any cardiac involvement representing genotypic-phenotypic heterogenicity

Key Strategies for Overcoming Psychological Insulin Resistance in Adults with Type 2 Diabetes: The UK Subgroup in the EMOTION Study

Introduction: Many patients with type 2 diabetes mellitus (T2DM) delay initiation of insulin therapy despite healthcare professional (HCP) advice. This phenomenon has been referred to as ‘psychological insulin resistance’ (PIR), and various contributing factors have been identified. Studies discussing approaches to overcoming PIR are lacking. Our aim was to identify the key strategies used by HCPs that most helped adults with T2DM and PIR in the UK to initiate insulin. Methods: As part of a global study, UK adults with T2DM and PIR were recruited (N = 125) to take a survey that included 38 HCP statements and actions about insulin initiation. Data assessed were perceived occurrence and helpfulness of these strategies in facilitating insulin initiation. Results: The most helpful strategies involved demonstrating the injection process (e.g. HCP talked patient through the process of taking insulin [83.6%]) and adopting a collaborative approach (HCP encouraged patient to contact the clinic immediately in case of any problems/questions [80.5%]). Additionally, HCPs highlighting the benefits of insulin (HCP explained that insulin was a natural substance needed by patient’s body [81.2%]) and allaying patients’ concerns (HCP explained that patient might not have to take insulin forever [78.0%]) helped patients initiate insulin. The least helpful action was HCPs repeatedly persuading patients to initiate insulin (40.9%). Conclusions: The study recommends key strategies that HCPs can adopt to help adults with T2DM overcome PIR in the UK

1. Report No. FHWA/TX-05/0-4420-2 4. Title and Subtitle Techniques for Mitigating Urban Sprawl 2. Government Accession No. 3. Recipient’s Catalog No. 7. Author(s)

Urban sprawl, driven by population and economic growth, is a pressing issue in the U.S., partly because of its contribution to growing levels of vehicle miles traveled (VMT). According to government figures, new development is gobbling up land at an alarming rate of 365 acres per hour (Natural Resources Defense Council 2002). Between 1960 and 1990, the amount of developed land in metro areas more than doubled, while the population grew by less than half (National Resource Defense Council 2001). In response, various efforts to mitigate urban sprawl have been and are being developed and implemented in different contexts and with different intents under the popular umbrella of “smart growth. ” Transportation plays an important role in these efforts. Transportation investments and policies can be used to influence development patterns, and policies that promote more compact development can help to slow the growth in VMT. This report identifies transportation-related and growth-management strategies and policy actions used in smart growth efforts and catalogues them with respect to goals, characteristics, and suitability factors in the form of six matrices, designed as a guide for communities in Texas in the selection of sprawl mitigation techniques appropriate to their specific contexts. The matrices were developed based on a

Characteristics, Treatment Patterns, and Economic Outcomes of Patients Initiating Injectable Medications for Management of Type 2 Diabetes Mellitus in Japan: Results from a Retrospective Claims Database Analysis

<p></p><p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s13300-018-0407-3">https://link.springer.com/article/10.1007/s13300-018-0407-3</a></p><p></p><p></p><p> </p><p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p><br><p></p